Shoulder injuries in the athlete

The team physician is constantly challenged with the treatment of musculoskeletal injuries, including those to the shoulder. Shoulder injuries are common in athletes, whether as a result of direct contact from a collision or from repetitive overhead motion. The predilection toward shoulder injuries in swimmers as an example is not unexpected, considering the biomechanics of the swim stroke and the training mileage logged by these athletes. The same can be said of football injuries; the trauma from tackling and falls to the ground understandably takes its toll on the shoulder girdle. The team physician caring for these athletes needs to understand the sport-specific demands placed on the shoulder in order to prevent as well as diagnose and treat injuries. This is not to say that there are shoulder disorders that are unique to any one group of athletes. Although various sports may place different demands on the shoulder and have specific injury patterns, many similarities do exist between sports that form a common thread for the treating physician. Athletes participating in contact or repetitive overhead sports are prone to shoulder disorders, the incidence of injury varying across types of sports as well as with level of athletic competition and the athlete's age. Shoulder problems are the most common musculoskeletal complaint in swimmers, occurring more frequently than injuries to the knee and back.(24) In these swimmers, shoulder injuries occurred with higher frequency in championship and elite competitors as compared with junior levels. In football, shoulder injuries are also reported with high frequency, ranking only behind those to the knee and ankle. At our institution, over a 5-year period, football injuries to the shoulder were the second leading cause of training room visits, as well as missed practices and games. As is true in other medical disciplines, certain musculoskeletal conditions are age related. Although shoulder problems may continue to be common in older athletes, the diagnostic possibilities change with increased age-related degeneration of tissues. Full-thickness tears of the rotator cuff are rare in young athletes but are seen more commonly with increased age, for example, in senior tennis players. This article reviews for the team physician current concepts in the evaluation and treatment of common shoulder injuries, with the focus on the younger athlete.